Common Consumer Health-Related Needs in the Pediatric Hospital Setting: Lessons from an Engagement Consultation Service

Daniel J. Lee; Robert Cronin; Jamie Robinson; Shilo Anders; Kim Unertl; Katherine Kelly; Heather Hankins; Ryan Skeens; Gretchen P. Jackson

doi:10.1055/s-0038-1667205

Applied Clinical Informatics, Inhaltsverzeichnis

Appl Clin Inform 2018; 09(03): 595-603
DOI: 10.1055/s-0038-1667205

Case Report

Georg Thieme Verlag KG Stuttgart · New York

Common Consumer Health-Related Needs in the Pediatric Hospital Setting: Lessons from an Engagement Consultation Service

Daniel J. Lee

¹Department of Urology, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States

²Department of Biomedical Informatics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States

,

Robert Cronin

²Department of Biomedical Informatics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States

³Department of Internal Medicine, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States

⁴Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States

,

Jamie Robinson

²Department of Biomedical Informatics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States

⁵Department of Surgery, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States

,

Shilo Anders

⁶Department of Anesthesiology, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States

,

Kim Unertl

²Department of Biomedical Informatics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States

,

Katherine Kelly

⁴Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States

,

Heather Hankins

⁷Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States

,

Ryan Skeens

⁴Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States

,

Gretchen P. Jackson

²Department of Biomedical Informatics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States

⁴Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States

⁸Department of Pediatric Surgery, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States

› Institutsangaben

Abstract

Background Informed and engaged parents may influence outcomes for childhood illness. Understanding the needs of the caregivers of pediatric patients is a critical first step in promoting engagement in their child's care. In 2014, we developed an Engagement Consultation Service at the Monroe Carell Jr. Children's Hospital at Vanderbilt. This service determines the health-related needs of the caregivers of hospitalized children and makes educational or technology recommendations to meet those needs and support engagement.

Objectives This report describes the most common health-related needs identified in the caregivers of hospitalized pediatric patients and details the recommended interventions to meet those needs.

Methods The most commonly reported consumer health-related needs from our 3-year experience with the Engagement Consultation Service were extracted from consultations notes. Each need was classified by semantic type using a taxonomy of consumer health needs. Typical recommendations for each need and their administration were detailed.

Results The most frequently recognized needs involved communicating with health care providers after discharge, using medical devices, distinguishing between benign and concerning symptoms, knowing what questions to ask providers and remembering them, finding trustworthy sources of information online, understanding disease prognosis, and getting emotional support. A variety of apps, Web sites, printed materials, and online groups were recommended.

Conclusion The parents of hospitalized patients share several common health-related needs that can be addressed with educational and technology interventions. An inpatient Engagement Consultation Service provides a generalizable framework for identifying health-related needs and delivers tools to meet those needs and promote engagement during and after hospitalizations.

Keywords

patient engagement - activation - health information technology - patient portal - mobile apps

Volltext

Referenzen

References
1 Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001
2 Stewart M, Brown JB, Donner A. , et al. The impact of patient-centered care on outcomes. J Fam Pract 2000; 49 (09) 796-804
3 Little P, Everitt H, Williamson I. , et al. Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ 2001; 323 (7318): 908-911
4 Maeng DD, Graf TR, Davis DE, Tomcavage J, Bloom Jr FJ. Can a patient-centered medical home lead to better patient outcomes? The quality implications of Geisinger's ProvenHealth Navigator. Am J Med Qual 2012; 27 (03) 210-216
5 Wolf DM, Lehman L, Quinlin R, Zullo T, Hoffman L. Effect of patient-centered care on patient satisfaction and quality of care. J Nurs Care Qual 2008; 23 (04) 316-321
6 Wanzer MB, Booth-Butterfield M, Gruber K. Perceptions of health care providers' communication: relationships between patient-centered communication and satisfaction. Health Commun 2004; 16 (03) 363-383
7 Hibbard JH, Greene J. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Aff (Millwood) 2013; 32 (02) 207-214
8 Maly RC, Bourque LB, Engelhardt RF. A randomized controlled trial of facilitating information giving to patients with chronic medical conditions: effects on outcomes of care. J Fam Pract 1999; 48 (05) 356-363
9 Hibbard JH, Greene J, Overton V. Patients with lower activation associated with higher costs; delivery systems should know their patients' ‘scores’. Health Aff (Millwood) 2013; 32 (02) 216-222
10 Hibbard JH, Greene J, Sacks RM, Overton V, Parrotta C. Improving population health management strategies: identifying patients who are more likely to be users of avoidable costly care and those more likely to develop a new chronic disease. Health Serv Res 2017; 52 (04) 1297-1309
11 Bollinger LM, Nire KG, Rhodes MM, Chisolm DJ, O'Brien SH. Caregivers' perspectives on barriers to transcranial Doppler screening in children with sickle-cell disease. Pediatr Blood Cancer 2011; 56 (01) 99-102
12 Hommel KA, Denson LA, Baldassano RN. Oral medication adherence and disease severity in pediatric inflammatory bowel disease. Eur J Gastroenterol Hepatol 2011; 23 (03) 250-254
13 Nicholson O, Mellins C, Dolezal C, Brackis-Cott E, Abrams EJ. HIV treatment-related knowledge and self-efficacy among caregivers of HIV-infected children. Patient Educ Couns 2006; 61 (03) 405-410
14 Warren JS, Brown CR, Layne CM, Nelson PL. Parenting self-efficacy as a predictor of child psychotherapy outcomes in usual care: a multi-dimensional approach. Psychother Res 2011; 21 (01) 112-123
15 American Hospital Association. Fast Facts on US Hospitals 2017; January 2, 2017. Available at: http://www.aha.org/research/rc/stat-studies/fast-facts.shtml . Accessed May 2, 2017
16 Collins S, Dykes P, Bates DW. , et al. An informatics research agenda to support patient and family empowerment and engagement in care and recovery during and after hospitalization. J Am Med Inform Assoc 2018; 25 (02) 206-209
17 Jackson GP, Robinson JR, Ingram E. , et al. A technology-based patient and family engagement consult service for the pediatric hospital setting. J Am Med Inform Assoc 2018; 25 (02) 167-174
18 Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res 2004; 39 (4 Pt 1): 1005-1026
19 Cronin RM, Fabbri D, Denny JC, Jackson GP. Automated classification of consumer health information needs in patient portal messages. AMIA Annu Symp Proc 2015; 2015: 1861-1870
20 Shenson JA, Ingram E, Colon N, Jackson GP. Application of a consumer health information needs taxonomy to questions in maternal-fetal care. AMIA Annu Symp Proc 2015; 2015: 1148-1156
21 Cronin RM, Fabbri D, Denny JC, Rosenbloom ST, Jackson GP. A comparison of rule-based and machine learning approaches for classifying patient portal messages. Int J Med Inform 2017; 105: 110-120
22 Robinson JR, Valentine A, Carney C, Fabbri D, Jackson GP. Complexity of medical decision-making in care provided by surgeons through patient portals. J Surg Res 2017; 214: 93-101
23 Osborn CY, Rosenbloom ST, Stenner SP. , et al. MyHealthAtVanderbilt: policies and procedures governing patient portal functionality. J Am Med Inform Assoc 2011; 18 (Suppl. 01) i18-i23
24 Video: Caring for My Child with a Gastrostomy; 2018. Available at: http://www.stlouischildrens.org/our-services/general-surgery/video-caring-my-child-with-gastrostomy . Accessed June 30, 2018
25 Caligtan CA, Carroll DL, Hurley AC, Gersh-Zaremski R, Dykes PC. Bedside information technology to support patient-centered care. Int J Med Inform 2012; 81 (07) 442-451
26 Kaziunas E, Hanauer DA, Ackerman MS, Choi SW. Identifying unmet informational needs in the inpatient setting to increase patient and caregiver engagement in the context of pediatric hematopoietic stem cell transplantation. J Am Med Inform Assoc 2016; 23 (01) 94-104
27 Kendall L, Mishra SR, Pollack A, Aaronson B, Pratt W. Making background work visible: opportunities to address patient information needs in the hospital. AMIA Annu Symp Proc 2015; 2015: 1957-1966
28 Miller AD, Mishra SR, Kendall L, Haldar S, Pollack AH, Pratt W. Partners in Care: Design Considerations for Caregivers and Patients During a Hospital Stay, CSCW: Proceedings of the Conference on Computer-Supported Cooperative Work. Conference on Computer-Supported Cooperative Work 2016; 2016:756–769
29 Miller Jr DP, Latulipe C, Melius KA, Quandt SA, Arcury TA. Primary care providers' views of patient portals: interview study of perceived benefits and consequences. J Med Internet Res 2016; 18 (01) e8
30 Keplinger LE, Koopman RJ, Mehr DR. , et al. Patient portal implementation: resident and attending physician attitudes. Fam Med 2013; 45 (05) 335-340
31 Carayon P, Hoonakker P, Cartmill R, Hassol A. Using Health Information Technology (IT) in Practice Redesign: Impact of Health IT on Workflow, Patient-Reported Health Information Technology and Workflow (Prepared by Abt Associated under Contract No. 290–2010–00031I). AHRQ Publication No. 15–0043-EF. Rockville, MD: Agency for Healthcare Research and Quality; May 2015
32 Kelly MM, Dean SM, Carayon P, Wetterneck TB, Hoonakker PL. Healthcare team perceptions of a portal for parents of hospitalized children before and after implementation. Appl Clin Inform 2017; 8 (01) 265-278
33 Frosch DL, May SG, Rendle KA, Tietbohl C, Elwyn G. Authoritarian physicians and patients' fear of being labeled ‘difficult’ among key obstacles to shared decision making. Health Aff (Millwood) 2012; 31 (05) 1030-1038
34 Adams JR, Elwyn G, Légaré F, Frosch DL. Communicating with physicians about medical decisions: a reluctance to disagree. Arch Intern Med 2012; 172 (15) 1184-1186
35 “Be More Involved with Your Health Care.” Agency for Healthcare Research and Quality. Available at: https://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/tips-and-tools/beinvolved.html . Accessed January 10, 2017
36 Steffens NM, Tucholka JL, Nabozny MJ, Schmick AE, Brasel KJ, Schwarze ML. Engaging patients, health care professionals, and community members to improve preoperative decision making for older adults facing high-risk surgery. JAMA Surg 2016; 151 (10) 938-945
37 “Record shares of Americans now own smartphones, have home broadband.” Pew Research Center. Available at: http://www.pewresearch.org/fact-tank/2017/01/12/evolution-of-technology/ . Accessed February 10, 2017
38 Morris D, Karlson A. Dynamic Accessibility Requirements for Hospital Patients, SIGCHI Conference on Human Factors in Computing Systems. Vancouver, BC, Canada: ACM Press; 2011
39 O'Leary KJ, Lohman ME, Culver E, Killarney A, Randy Smith Jr G, Liebovitz DM. The effect of tablet computers with a mobile patient portal application on hospitalized patients' knowledge and activation. J Am Med Inform Assoc 2016; 23 (01) 159-165
40 Vawdrey DK, Wilcox LG, Collins SA. , et al. A tablet computer application for patients to participate in their hospital care. AMIA Annu Symp Proc 2011; 2011: 1428-1435
41 Cimino JJ, Patel VL, Kushniruk AW. The patient clinical information system (PatCIS): technical solutions for and experience with giving patients access to their electronic medical records. Int J Med Inform 2002; 68 (1-3): 113-127
42 Stevens VJ, Glasgow RE, Hollis JF, Lichtenstein E, Vogt TM. A smoking-cessation intervention for hospital patients. Med Care 1993; 31 (01) 65-72
43 Mahler HI, Kulik JA. Effects of preparatory videotapes on self-efficacy beliefs and recovery from coronary bypass surgery. Ann Behav Med 1998; 20 (01) 39-46
44 Chennupati S, Dorst M, Anders SH, Jackson GP. Technology usage and preferences during pregnancy. Poster presentation at the AMIA 2016 Annual Symposium, Chicago, IL, November 14, 2016